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We are carrying out checks at Sheringham Medical Practice. We will publish a report when our check is complete.

Reports


Inspection carried out on 09 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection December 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Sheringham Medical Practice on 09 January 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had risk assessments in place to reduce the risk to patients. When incidents did happen, the practice learned from them and improved their processes.

  • The practice had systems to safeguard children and vulnerable adults from abuse. The practice told us they followed up that had children not brought to appointments; however documentation in clinical notes did not always support this.

  • There was a system to manage infection prevention and control (IPC).

  • We found medicines and some other items on the emergency trolley to be out of date. These were removed immediately.

  • Significant events and complaints were well managed in the practice. The practice kept an overall log of significant events and complaints.

  • There was a system for receiving and acting on safety alerts. In the dispensary, there was a clear system and log of events and actions such as alerts relating to recall of medicines. However, the documentation of the alerts that were managed by the GPs and management team did not clearly evidence that actions had been taken.

  • The system for the follow up of patients that had diabetes in pregnancy was ineffective and did not always evidence a review of patients after pregnancy.

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided and had completed 29 clinical and non-clinical audits. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • The practice achieved 99.9% of available points within the Quality and Outcomes Framework.

  • Staff involved and treated patients with compassion, kindness, dignity and respect. Patients we spoke with reflected this view, as did the CQC comment cards.

  • The practice were above or in line with local and national averages for the GP patient survey questions relating to access.

  • The practice held many informative days for patients on areas such as cancer, carers and dementia. All staff were trained in dementia awareness.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation and the practice were keen, where possible, to upskill staff.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review and improve the documentation in clinical notes for children that were not brought to appointments.

  • Review and improve the system for the management of patients that had diabetes in pregnancy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 16 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sheringham Medical Practice on 16 December 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
  • The practice had a clear strategic vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw three areas of outstanding practice:

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. For example, the practice had organised an event to raise awareness of dementia. They had also been an active participant in Sheringham’s “Dementia Friendly Community” initiative, as well as working to become a “Dementia Friendly Practice” with special dementia signage and other dementia friendly facilities.
  • The practice had proactively sought feedback from patients and had an active patient participation group (PPG) which was fully representative of the local demographic. The practice worked closely with the local secondary school, and had encouraged pupils to join the virtual PPG.
  • The practice demonstrated a proactive approach to professional development for all members of staff. Staff were encouraged and supported to undertake further educational qualifications and clinical training to enhance the service, including research roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.